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Narratives of Diversity: Encouraging Cultural Responsiveness

By Jim Stubenrauch

What’s especially exciting about writing with a group of people in a workshop setting is the opportunity it affords to witness others giving their stories form and bringing them into the open, in real time. Sometimes, it’s astonishing what people can produce in just a few minutes.

I recently teamed up with two colleagues, nurse practitioner and nursing educator Dr. Kenya Beard and poet and writing teacher Joy Jacobson, to present Narratives of Diversity: Encouraging Cultural Responsiveness, a daylong workshop held at the CUNY Graduate Center. The goal of the day was to achieve a better understanding of how students, patients, and professional colleagues experience themselves and others in increasingly diverse health care and educational environments. Participants explored their own experiences of diversity and marginalization through guided creative writing exercises and discussion and, together, we sought strategies that all of us could use to become more culturally responsive, both personally and in our professional roles. (To learn more about Kenya’s work in promoting multicultural education and reducing health disparities, see Joy’s interview with her, here.)

Shannon Richards-Slaughter, left, with her mother, Rose Richards, ca. 1987

Shannon Richards-Slaughter, left, with her mother, Rose Richards, in 1987

One of the workshop participants, Shannon Richards-Slaughter, an educator and writer from Charleston, South Carolina, wrote a first draft of the following piece during a 20-minute guided writing session and then shared it with the group. The prompt was: “Write about a time when you felt marginalized or witnessed someone else being marginalized.” Shannon’s story isn’t primarily about something that occurred in an institutional or professional setting; rather, she used the idea of marginalization to examine her increasingly tenuous connection to her mother, who is slowly withdrawing from her relationships with friends and family. Anyone who has provided long-term care for an aging loved one will recognize the complex, sometimes conflicting emotions Shannon expresses in this poignant and heartfelt piece. Our great thanks goes to Shannon for sharing this with HealthCetera‘s readers.

Heart on Automatic

We have marginalized my mother. Or has she marginalized us? She’s 96 and stays all day in her bedroom, our former guest bedroom. That’s how she acts. Like a guest. Like someone just passing through. Physically, she’s fine, her doctors say: blood pressure, pulse, and—now, with the pacemaker—heart. All fine. She takes less medicine than my husband and I do. But she is far away, and in some ways, we have let her go. At first, I took her to all the specialists—the gerontologist, the neurologist, the psychologist, the psychiatrist. There were work-ups and tests and consultations:

She might be depressed.

No, it’s not Alzheimer’s.

It could be an eating disorder associated with the elderly.

No, it’s atrophy of the capillaries of the brain.

It’s not dementia. We can’t say it’s dementia.

Maybe, it’s a form of dementia…

She’s traveled so far away from her family, her friends, to live with us. She’s obsessed with finding out where she is, sometimes asking me, “What happened to the house?” Meaning the house she’s lived in for over fifty years, 1004 North Michigan Avenue in Atlantic City.

“What happened to the house?”

As if the house has disappeared because she can’t see it. As if it doesn’t exist because she’s not in it. It’s still there, we tell her. You’re just staying with us now. We beg her to come, sit with us around the kitchen table, have dinner with us. Please. Don’t sit over there on the sofa by yourself. Join us, be with us.

“I’m ruining your life,” she says. “I’m making trouble.”

And she is and she does when she refuses to take her medicine, to get dressed, to eat anywhere but in her bedroom, to talk to her sisters long-distance on the phone. She is so unhappy and so angry. We take her back then, to 1004 North Michigan Avenue, because maybe, just maybe, if she is in her own home, back among her own surroundings, siblings, friends, maybe then she’ll do better. But she is unhappy and angry and won’t eat and doesn’t like the lady who comes in to help her.

We bring her back. This time to Ashley River Plantation, an assisted living facility which is supposed to give her independence and dignity and where she stays in her room all day and asks, “What is this place again? Am I on assistance?”

Finally, it’s back at our house when she asks, “Where am I now?”

“Charleston,” I say.

“But where in Charleston?”

“My house.”

She turns away. Swimming out to some other shore. And we have let her go. I have let her go.

I take her meals up to the room and tell her what’s on the plate. I turn on the lights so she won’t be always in the dark. Every now and then I take her to the beauty parlor and the podiatrist.

She will not go to church.

I take her to the doctor where they tell us the same things:

Get her to eat.

Make sure she takes her meds.

Keep her active.

But we’ve heard it all before, and my heart is on automatic, a remorseless machine pumping energy into my care of her. I feel the line attaching us grow increasingly slack. She is beyond my reach.

Rose Richards in 2003

Rose Richards in 2003

Shannon Richards-Slaughter is a faculty member in the Writing Center/Center for Academic Excellence at the Medical University of South Carolina. She regularly meets with health professions students from all six of the university’s colleges to review a variety of writing assignments, including literature reviews, research papers, papers for publication, capstone projects, dissertations, scientific papers, and grant proposals. Nursing students make up the majority of her Writing Center appointments. In another life, she has been a playwright and a fiction writer, most notably winning the New Professional Theatre 2005 Writer’s Festival Award and the Ms. Magazine College Fiction contest.

Jim Stubenrauch is a senior fellow at the Center for Health, Media & Policy and teaches writing at the Hunter-Bellevue School of Nursing.

Improving Food Access in the Bronx one HealthBuck at a time

This post is written by Senior Fellow, Charmaine Ruddock MS. She directs Bronx Health REACH, a coalition of 50 community and faith-based organizations, funded by the Centers for Disease Control’s REACH 2010 Initiative to address racial and ethnic health disparities.

Screen shot 2014-07-30 at 9.10.50 AM

Yesterday morning, I and many of the partners Bronx Health REACH collaborates with, and those we hope to collaborate with in the future, met up at the press conference of Council Member Ritchie Torres to announce the historic funding for HealthBucks that he secured in the 2015 New York City budget.  It is historic not because it launched the HealthBucks program. HealthBucks is a New York City Department of Health initiative launched several years ago. It is historic because for the first time funding was secured from the City Council through the advocacy of this newly elected City Councilman at the behest of over 1700 of his constituents. So many elements were there that makes me happy about the work that I do. There were the partners- the Bronx District Public Health Office, New York League of Conservation Voters, GrowNYC, Mary Mitchell Center and the children from their programs, Union Community Health Center, iconic urban farmer and gardener extraordinaire – Karen Washington, a politician and his staff present and striving to meet the needs and demands of a community. There was the setting, Poe Park named for Edgar Allen Poe, with the house he lived in for the last years of his life nestled in one corner of the park.  A treasure right here in the Bronx. And, there were the community residents in teeming numbers, crowding the farm stands, carrying two, three, four bags filled with produce. Produce so fresh that the scents of cilantro and other herbs filled the air. And, there were the farmers, smiling and intent because business was brisk and demand was high.  When I hear and/ or read that people in the poor neighborhoods in the Bronx are not interested in buying and eating fresh produce, I think of this Bronx that I see, that gets me excited and gives us all hope.

Listen up! ACA updates & Dior Vargas: Latina feminist & mental health activist

HealthCetera, Healthstyles regular health news feature produced for Michael G. Haskins’ program,  Haskins in the Morning, on WBAI 99.5 FM Pacifica Radio, aired this morning. This segment reported on news from the Washington Post article, Study: 10M have gained coverage through health law and Charles Ornstein’s  Federal Health Exchange Stays Busy After Open Enrollment Ends published 7/23rd NPR’s Shots. Listen 

It also includes a message from Dior Vargas, Latina feminist mental health activist, who launched Speak Out! Minority Mental Health Awareness Month, on her blog inviting others to share their stories about living with a mental health issue.

According to the U.S. Department of Health and Human Services Office of Minority Health,  “Nearly two-thirds of people with a diagnosable mental illness do not seek treatment, and racial and ethnic groups in the U.S. are even less likely to get help, according to the National Alliance on Mental Illness.”

It is critical that we identify and bridge the gaps in access to culturally competent care and support for people living with mental illness. Listen to Ms. Vargas below.

A Small Win in the War against Obesity and Overweight in the Bronx

This post is written by Senior Fellow, Charmaine Ruddock MS. She directs Bronx Health REACH, a coalition of 50 community and faith-based organizations, funded by the Centers for Disease Control’s REACH 2010 Initiative to address racial and ethnic health disparities. 

Screen shot 2014-07-29 at 7.59.28 AM

Last January with snow blowing in our eyes and crusting our cheeks, and our feet sinking ankle deep in snow drifts, two of us from Bronx Health REACH and our partners from the Mary Mitchell Family and Youth Center and the New York League of Conservation Voters visited newly elected City Council Member Ritchie Torres and his staff to deliver more than 1500 post cards from his constituents. Those postcards, lying on the table in this picture, demonstrated the importance to the residents in District 15 of having more of the City’s HealthBucks which allows them to purchase fresh produce at their neighborhood farmers markets.

Next Tuesday, July 29th , community residents, along with those of us who trudged through that snowstorm and other partners such as the Bronx District Public Health office and GrowNYC will stand with the Council Member at a press conference to announce that he secured an unprecedented $10,000 in New York City’s 2015 budget for HealthBucks for Bronx residents.  In a county that, according to the recent Robert Wood Johnson County Health Rankings report, is ranked 62 out of the 62 counties in New York State in health outcomes, and which has some of the highest rates of diet related diseases this is a win for Bronx residents and the farmers markets that offer them healthy food options in an area where there is such a lack. Collaborations such as this with elected leaders who lend their support to efforts  to improve the communities health is good public health.  

“Are You My Nurse?” The Importance of Claiming Professional Identity

This post is from CHMP Graduate Fellow, Amanda Anderson, RN’s blog, This Nurse Wonders. More frequently than not, Amanda writes toward her simple goal, “I want nurses to start talking.” Here, she muses on the importance of using titles in health care.

By neglecting to title ourselves, we allow others to paint us as whatever stereotype is the most convenient, or the most useful. Work by Richard Prince, Registered Nurse. 2002.

By neglecting to title ourselves, we allow others to paint us as whatever stereotype is the most convenient, or the most useful. Work by Richard Prince, Registered Nurse. 2002.

In their book, From Silence to VoiceBernice Buresh and Suzanne Gordon discuss the silence of the nursing profession in the media. Chapter after chapter, they expose how reluctant we are to share with the public the details of our job, how we hide behind the stereotypes and discriminations of our profession, and, most importantly, what we lose because of this silence.

I’ve picked it up again, after my first read years ago. It’s funny, to see the notes I scribbled in the margins then. Lots of ?!?!? and WHY DO WE DO THIS?! It’s not so funny, seven years later, to realize how much remains unchanged.

Over the weekend, on a bus ride back from a quick DC trip to see my sister, I read the chapter entitled, “Presenting Yourself As A Nurse.” I remember reading this so long ago, thinking their recommendation to introduce myself as “Nurse Anderson,” while expecting other providers to address me as such, seemed kind of dated. Do I want to be called Nurse Anderson by interns who are now, a growing handful of years younger than me? Kind of feels like being called “ma’am” by a stranger in the grocery store.

But they make a good point: the discrepancy between doctor’s and nurses title usage – doctor’s always introduce themselves as such, while nurses are often the mysteriously untitled profession – solidifies physician-identity in the mind of the patient and, ultimately, the public. Sure, when chatting at the nurses station, first-name basis between providers is fine, but in introductions to patients or family, first-name-only-nurses surrender their professional identity.

I floated to endoscopy yesterday. Assigned to man the recovery room with two other nurses, I pondered this identity challenge, and decided to conduct some experiments. As sleepy patients wheeled in from their various procedures, I’d give them a little shake, and with Buresh and Gordon in my brain, I’d say, “Hello! I’m Amanda, I’m a nurse,” to their crusty-eyed, confused gaze. Just coming out of twilight anesthesia, many marveled at the simplicity of my greeting, and its ability to provide them with much needed context. Not one of them asked me where they were, or who I was, and honestly, it felt good to title myself openly.

I used my new, identity-charged greeting all shift – when I called the pharmacy for medications, I said, “Hi! I’m Amanda, I’m a nurse calling from endoscopy.” When I phoned the operator to connect me to another unit, “Hi! I’m Amanda, I’m a nurse,” came easily, and I was shocked at how clearly it was received, and how many clarifications it saved me.

While I fluidly added my title to my introductions, making them direct and clear, I was amazed at how muddled and ambiguous my co-nurse’s greetings sounded in contrast. Smiling down at her sleepy patients, she said, time and time again: “Hello! I’ll be taking care of you.” Huh? Where am I? Who are you? Were the most common responses.

I’ll admit, I’ve said this phrase countless times. But hearing it in the shadow of Buresh & Gordon’s recommendations, made me wonder why we nurses think it’s acceptable – are we ashamed to call ourselves “nurse,” or do we just not recognize how important our title is?

In an era where nurses no longer have a recognizable image, where we all work in different capacities and at different levels, and where our education and practice is frequently called into question, it is becoming clearer and clearer how closely-linked the act of verbal title distinction is to our professional success. By neglecting to state who we are – the nurse – we give up control of our identity, our rights to our work, our voice as a profession; our silent namelessness allows us to become whatever stereotype is the most convenient, or the most useful.

My titling experiment cemented itself into forever-practice around three pm, when I prepared to call report on a patient who was returning to her bed on the floor. I asked the patient if she knew her nurse’s name, to speed up the phoning process. She told me it was Samantha, who I requested when I phoned the unit. “Oh, Samantha is the nurse’s aide, I’m Jane. I’m the nurse.” Damn.

All that work, all that time, all that expertise, all that knowledge, and the patient still has no clue who we are. A simple switch of the tongue might be a start to something big, nurses. While I may not introduce myself as Nurse Anderson just yet, I’ll definitely be seasoning my communications with my title from here on out.


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